Clinical and functioning outcomes during the establishment phase of Ukraine's community mental health teams: a...

Ukraine's nationwide Community Mental Health Teams (CMHTs) programme is key to Ukraine's ongoing mental healthcare reform. No studies to date, however, have reported on the impact of Ukrainian CMHTs on service user clinical recovery. This study has two aims: (i) describe who the Ukrainian CMHTs are enrolling, which services they most provide, and where they are provided and (ii) identify whether any clinical and/or functional improvements were detectable among service users after six CMHT visits (intake + five follow-up visits) and, if so, identify principal predictors of such improvements.

947 CMHT service users enrolled between April-December 2021 were assessed on clinical outcomes using the Clinical Global Improvement scale (CGI) and functional outcomes using WHO's Disability Assessment Schedule (WHODAS 2·0). Chi-square and Wilcoxon signed-rank tests were used to assess changes in CGI and WHODAS scores, respectively, at the fifth (or fourth) follow-up CMHT visit. Hierarchical multinomial logistic regression and hierarchical multiple linear regression identified predictors of clinical and functional improvement, respectively.

Most service users were male, unemployed, and diagnosed with schizophrenia spectrum disorders. Among service users with available outcome data at both CMHT intake and the fifth (or fourth) follow-up visit, a significant decrease in disability scores was observed (Median_intake = 62·50, Median_follow-up = 58·33, z = -6·27, p < 0·001) and most service users' illness severity stabilised (n = 451/742, 60·8%) or improved (n = 243/742, 32·6%). Clinical stabilisation (compared to worsening) was predicted by being male and living <20 km from the CMHT office, while improvement was predicted by frequent receipt of pharmacological support and receiving CMHT care in non-conflict-exposed regions. Functional improvement was predicted by living between 20 and 100 km from the CMHT office, having a somatic comorbidity, more frequent receipt of psychosocial services for the service user's family, and more support for community integration.

We found positive results associated with enrolment in Ukraine's CMHTs. Recommendations for future research and improvements to the CMHT programming are provided.

Funded as part of the World Health Organization's Special Initiative for Mental Health.